NPIMap

Individual provider Active NPI

Taylor Davis Fulks, DO

  • Family Medicine Physician
  • Hattiesburg, MS
National Provider Identifier
1295300085
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30159 Issued in MS
Practice address
415 S 28TH Ave FL 1
Hattiesburg, MS 39401-7246
Phone
(601) 288-5200
NPI assigned
May 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30159 MS Primary

Addresses

Primary practice location

415 S 28TH Ave FL 1
Hattiesburg, MS 39401-7246

Mailing address

PO Box 15722
Hattiesburg, MS 39404-5722
Phone (601) 288-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250115002144 MS Practitioner - Family Practice 2769870237 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forrest County General HospitalGroup PAC ID 1052397767, 107 clinicians

Practice addresses (Care Compare)

415 S 28TH Ave
FL 1
Hattiesburg, MS 39401-7246
Phone (601) 579-3300

Hospital & facility affiliations

  • Forrest General Home Care Home health agency, Hattiesburg, MS, CCN 257127
  • Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078
  • Highland Community Hospital Hospital, Picayune, MS, CCN 250117

Merit-based Incentive Payment System (MIPS)

Final score
98.92 of 100Reported as apm
Quality
90.2
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Oct 7, 2024 Accepting new patients
Forrest County General Hospital Current Accepting new patients
Forrest County General Hospital CurrentSince Oct 7, 2024 Accepting new patients
Forrest County General Hospital Past Accepting new patients

Locations

415 S 28th Ave
Fl 1
Hattiesburg, MS 39401
Phone (601) 288-5200

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

Organizations & group practices 26

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 26

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1295300085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15722",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394045722",
            "telephone_number": "601-288-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE FL 1",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-288-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULKS",
        "first_name": "TAYLOR",
        "middle_name": "DAVIS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-24",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "30159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.